Login Username or email address * Password * Remember me Log in Lost your password? Register First Name * Last Name * Country * Select a country... Åland Islands Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belau Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda São Tomé and Príncipe Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (Dutch part) Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom (UK) United States (US) United States (US) Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Street Address * Town / City * Phone * Email address * Password * Birth date * Gender * Female Male Height (eg 165 cm) & Weight (eg 65 kg) Emergency Contact Name & Number Relation to You Primary Care Physician Name & Phone Number How did you hear about Defy? * Heard from friend Searched online Got an email about us Facebook Pass by Medical Questionnaire Are you currently pregnant? Yes No Please list any medical conditions you are currently being treated for. Do you currently have or have you ever had? (check all that apply) High Blood Pressure Low Blood Pressure Any Heart Disorder/Disease Flutters or Arrhythmias Any Valve Disease Coronary Disease/Heart Vessel Disease Any Heart Surgery Heart Attack (in the last 6 months) Pacemaker Peripheral Artery Occlusive Disorder Raynauds Disease Vasculitis COPD Active Shortness of Breath Asthma Bleeding Tendency Severe Anemia Loss of Consciousness Seizures/Epilepsy Bacterial or Viral Infection of the Skin Scleroderma Kidney or Urinary Tract Infection Cancer Hypothyroidism or Hashimotos Hyperthyroidism or Graves Diabetes Claustrophobia None Do you have weak/lack of sensation in extremities? Yes No Do you have any wounds? Yes No Any other disorder or illness not listed above? (please explain) What is your biggest health concern at this time? Do you currently feel healthy? Yes No If you could improve one thing about your health, what would it be? Safety Instructions and Waiver of Liability * No I understand the safety instructions provided and I also agree that I do not have any of the contraindications listed and I understand and accept the possible risks of Cryotherapy and Floatation. And I voluntarily agree to each term and provision herein and sign this of my own will. Register